HC Deb 11 April 1968 vol 762 cc1667-80

3.27 p.m.

Dame Irene Ward (Tynemouth)

A month or two ago I attended a very important meeting in the Newcastle General Hospital. I was not there as a guest but in a capacity which I hold in relation to some of the organisations connected with the Health Service. It was a conference of many people connected with the Health Service and it was held in the new postgraduate section which has recently been built in the grounds of Newcastle Hospital.

While I was there my attention was directed to the plan for the proposed new Freeman Hospital which is to be built in Newcastle-upon-Tyne. I had the advantage of many people present at that meeting of hearing views of the plan which was displayed. I fully realised that if I had not been at the meeting I probably should not have had an opportunity to see the plan, and I was grateful, for a variety of reasons, that I was able to see it. Certain details were pointed out to me with great annoyance, anger and criticism by the very distinguished company present at the meeting. The plan showed, in the main corridor of the hospital, that the mortuary was to be adjacent to the dining room. That, naturally, did not commend itself to those connected with the hospital service in my part of the country.

On 20th February I put down a Question to the Minister of Health asking whether he was aware of the criticism of the plan and whether he would take action to see that the mortuary was not placed next to the dining room. He replied: No plans for this hospital have yet been submitted to my right hon. Friend."—[OFFICIAL REPORT, 20th February, 1968; Vol. 759, c. 74.] It is a pity that in hospital planning, which is the key to our whole hospital service, the Minister does not have in mind the plans that are being prepared by the Ministerial architects. I was not satisfied with that Answer, so on 23rd February I tabled a Question to the right hon. Gentleman asking for … an assurance that no plan for the Freeman Hospital … will be agreed to by him which includes a dining room adjacent to a mortuary". I received what seemed a reasonable reply, for the Minister told me: Yes. I am informed that the Hospital Board has never contemplated such an arrangement ".—[OFFICIAL REPORT, 23rd February. 1968; Vol. 759, c. 204–5.] I wondered if I had not read the plan correctly or that, in having it pointed out to me, I had failed to appreciate its detail. I accept that in many instances the layman is not able to read plans of this sort adequately. Instead of tabling another Question, I wrote to the Minister explaining exactly what had happened. I wrote that I hoped that in the Questions I had asked I had not reached an incorrect conclusion, particularly having regard to what I thought was a reasonable assurance from the Minister. On 14th March I received this reply from the right hon. Gentleman: You wrote to me on 29th February following my reply to your recent Parliamentary Question concerning the Freeman Hospital, Newcastle. The position is that the Regional Hospital Boards are responsible for planning individual hospitals, assisted by general guidance from my Ministry. The Regional Board architects are producing the plans for the new hospital to be built on the Freeman Road site, the design of which is at a relatively early stage. I have not, as I said in reply to your earlier Question, yet received final plans for the hospital for consideration by my Department because the Regional Board is still at work upon them. My advisers will have an opportunity to study the plans when they are formally submitted by the Board. No date was given about when the plans were expected. The letter went on: Meanwhile I understand from the Board that as the draft sketch design stands at present, the mortuary will be on the same floor as the dining room but remote from it, in fact 60 yards away. That is not my idea of remote. The letter went on: It will have two points of access, one of which will be on the opposite side of the building from the dining room and from which will go bodies leaving the mortuary for the hospital grounds. Access to the mortuary from the main corridor will be via pairs of double doors forming air locks. The mortuary will have full extract ventilation. Its position reflects the opinions of the consultant pathologist. The letter contained this significant sentence: The relationship is, of course, even so riot what one would ideally like to see and special attention will be paid to it and the internal traffic flow arrangements when the plans are submitted to me. The letter concluded: Yours sincerely, Kenneth Robinson. As far as I can see, the Minister was interested only in giving me the architectural points about the mortuary. I was not criticising the architectural design of the mortuary. I would not be in a position to do that. I am perfectly satisfied that the mortuary will be situated in such a position that it would be adequately provided for. The Minister need not have wasted his time telling me about the architectural details.

It is reasonable to suppose that if a mortuary has access from a main corridor down which pass hospital staff, visitors, patients and the whole range of people whom one always meets in great hospitals, it will have an effect on them. I am concerned, as were those who showed me the plan at the meeting, by the reaction of people going to the dining room and having to pass the main entrance to the mortuary.

We know that there is a great deal of happiness in hospitals, and that wonderful things happen there of which we are all very proud, but there is also a great deal of sadness, and sickness and final failure there. I do not think that it will add greatly to the happiness of the hospital staff, who give such great service to the nation as a whole, if their meal breaks, which intersperse periods of very hard work, are taken in such conditions. They are not likely to be made happier by having to pass the entrance doors to the mortuary when going to the dining room.

As I say, my purpose is not to complain of the architectural detail of the mortuary. I believe that no one in his sane senses, planning a new hospital, could think it right to put the doors to the mortuary on the main corridor leading to the dining room. It is an absolutely first-class psychological blunder.

In the final sentence of his letter the Minister agrees that this is not an ideal plan. I think that when we are spending hundreds of thousands of pounds on new hospitals that will probably last 50 years, we want an ideal plan. We do not want a plan that is not ideal, but one that is acceptable and suitable, and the best we can provide.

During a recent visit to a big hospital in Yorkshire I spoke about this matter of the mortuary and the dining room. If I understood correctly what was said to me, this is a new standard design for hospitals. If so, it is quite intolerable. A day or two after I was given that information I noticed that the Minister had publicly announced that we are to standardise hospitals. If that is so, the standard design must presumably come from the Ministry, and be taken out of the hands of regional hospital boards. If we are to have a standard design, I want to be sure that it is the very best design from the point of view of the treatment of the sick and the comfort of the staff. These things are not incompatible.

I have a great respect for the Minister, even though I do not often agree with him. I know that he is desperately interested in this matter. I simply cannot understand how he can say that this is not an ideal situation and go on to say that matters of traffic flow will be dealt with when the plan comes to him. That is nonsense because he or someone should have seen the plan at the earliest stage. We would wait for years for hospitals to be designed if they could be proceeded with only after the plans had been submitted in that way. I am absolutely horrified by the whole thing.

If the Minister and all concerned, regional hospital boards, pathologists, matrons, doctors, nurses, radiographers and all the rest have no chance of saying anything about a plan, I do not think we should be satisfied with Ministerial architects. I do not know whether the Ministry employs private architects, nor whom they are. Perhaps the Minister will listen to me. He does not need to get information now; he should have had it long ago. Who are the architects? Are they paid by the Ministry, or does the Ministry engage private architects? If there were private architects in this case I should like to know who they were. I should like to make a fuss and to know what extraordinary architects designed this hospital. I want answers to these questions. The present plan does not satisfy me. It does not satisfy those working in the hospital service in the North, and it certainly will not satisfy all those who are looking forward to the new Freeman Road Hospital to be established in Newcastle-upon-Tyne.

While I have the great good fortune of having the Parliamentary Secretary present, I wish to raise another question. It refers to architects. My father was an architect and I do not like criticising them. I am not all that keen on them, however, if this is to be the kind of design which they bring forward for a hospital, unless they have been told that this is the most economical way of dealing with the matter, that the Minister is proposing that they should cut down on the space and have the mortuary adjacent to the dining room.

Not long ago the first-class medical administrator at Preston Hospital in my constituency was very worried because there were not enough pre-natal beds there. He was of the opinion, although he could manage with the maternity beds which were available, that there were mothers who should be in hospital before their children were born so that doctors could keep an eye on them. It worried him and the whole of the staff in that very efficient hospital that there was not accommodation for pre-natal cases. The hospital had a little land available and the medical administrator could easily have had a small ward established at not great expense which would enable him to keep an eye on women whom he thought should be in hospital before the birth of their children.

The administrator had to obtain permission from the regional hospital board. Once he approached the board, the architects descended. By the time they had prepared their plans, the sum required to build the small ward in accordance with the architect's design was so enormous that the scheme had to be abandoned. The right hon. Lady who is now the key pin on economic matters should be told that my constituency would have increased its productivity if it had not been for Ministerial architects. Productivity agreements are needed for professionals as well as for industrial people. I do not like the present arrangement.

We did not get our small maternity ward. If we make this suggestion again I suppose the costs will have mounted to such an extent that we shall not be able to have the little ward. All this information came to me legitimately. It cannot be said that I saw something that I should not have seen or that somebody showed me something that I should not have been shown. I always pay attention to what people in the North of England tell me. They often know much more than the toffs in the Ministry of Health, whom you cannot get at. It has taken me an inordinate amount of time to raise this matter.

The Minister did not say that he would withdraw the plan and ask the architects to produce a new one. He merely said: The relationship is, of course, even so not what one would ideally like to see and special attention will be paid to it and the internal traffic flow arrangements when the plans are submitted to me. What on earth does that mean? If the design is such that the mortuary is on the main corridor adjacent to the dining room, how can the Minister deal with the traffic flow, if the doors which he described in such detail are there and if the bodies must go through the mortuary from the main corridor out into the hospital grounds? How can he alter all that when the plans are submitted to him? I repeat that the situation is absolutely deplorable.

I believe that the Parliamentary Secretary will tell me the channel of communication for architects' plans for hospitals. Who sees these plans? It is no good saying that the consultant pathologist is satisfied with the design of the mortuary. What has he to do with the nurses, visitors, doctors, medical staff, and so on? It is the most deplorable letter on such a subject that I have ever received. I look forward to receiving a satisfactory answer so that, if we are to go in for standardised hospitals, I shall know that we shall have first-class hospitals which, though they cost a great deal of money, will last a long time.

3.50 p.m.

Mr. Geoffrey Rhodes (Newcastle-upon-Tyne, East)

I am following the debate with considerable interest, as the hospital in question, the Freeman Road Hospital, is in my constituency, and the catchment area which it will serve as a district general hospital is principally in my constituency and that of my hon. Friend the Member for Wallsend (Mr. Garrett). Moreover, it will be situated only a few yards from my own front door.

I have noted the legitimate complaint of the hon. Lady the Member for Tyne-mouth (Dame Irene Ward) with some interest. I merely observe that, if the mortuary is to be situated 60 yards away from the dining room, then, unlike the hon. Lady, I should regard that in building terms as a considerable distance, certainly sufficient to meet the major part of the abjection which she raised. However, I regard it as a legitimate complaint, and I hope that my hon. Friend the Parliamentary Secretary will comment on future planning of hospitals in this respect.

I believe that, for several months—certainly up to a few months ago—many consultants in the area have been conducting a persistent sniping campaign against the whole conception of a third hospital at Freeman Road in Newcastle-upon-Tyne. Now that they have been defeated on the principle of the thing and the third hospital project has been confirmed by my right hon. Friend, I hope that there will now be no persistent rearguard campaign. I say that although I am in no way opposed to people seeking improvements in the plans for hospitals, even at this stage. Indeed, one reason for the delay in the finalising of some of the plans arises from the very pressures of the consultants themselves to have the plans changed.

I am pleased that the hon. Lady accepted, as we all must do now, that there will be a third hospital in Newcastle-upon-Tyne. As a district general hospital, it will serve a catchment area comprising 150,000 people, principally in Walker, Byker, Heaton, and High Heaton in my constituency and South Gosforth and Longbenton in the constituency of my hon. Friend the Member for Walls-end. It is only right and proper, therefore, if we are to have such a key hospital for the area, that it should be architecturally right. I accept that point from the hon. Lady. But I hope that we shall not, over the next few years, have a continuation of the sort of sniping we have had from the consultants during the past year.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow) rose—

Dame Irene Ward

Before the hon. Member for Newcastle-upon-Tyne, East (Mr. Rhodes) sits down—

Mr. Snow

No. I must make my reply. The hon. Lady spoke for—

Mr. Deputy Speaker (Sir Eric Fletcher)

Order. The hon. Member, having already spoken in this Adjournment debate, may speak again only with the leave of the House.

Dame Irene Ward

I was not going to speak—

Mr. Deputy Speaker

Order. I was pointing out that the Minister may speak again only by leave of the House as he has already spoken in this Adjournment debate.

Dame Irene Ward

I beg your pardon, Mr. Deputy Speaker. I was going to say—

3.53 p.m.

Mr. Snow

I shall not give way. May I have the leave of the House to speak a second time?

The hon. Lady the Member for Tyne-mouth (Dame Irene Ward), who did not consult my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Rhodes), must take responsibility for the terms in which she expressed her complaint against the architectural plans for this hospital. I am sorry that she did not speak to my hon. Friend. If she had, we might, conceivably, have had a more balanced point of view given. However, I concede at once that the specific point which the hon. Lady raised about the location of the mortuary is a perfectly justifiable one to raise. I do not resent it at all, and I hope to give her a reasonable explanation of what is going on. Before coming to that, however, I shall refer to her secondary point about the Preston hospital.

The position regarding the Preston hospital is not as the hon. Lady stated it, and neither is the development to which she referred at all conditioned by the factors she outlined. A scheme for the provision of six extra ante-natal beds at Preston hospital was first put forward in 1961. But the Board did not consider this scheme of sufficient priority to be included in its capital programme. Since then, various representations have been made to the Board, but the position as regards priority has remained unchanged. It is now apparent both to the Board and to the Management Committee that the provision of additional maternity beds in the south-east Northumberland area is not of first priority. This is due to the change in the length of stay of patients and the effects of the provision of additional maternity beds in the Newcastle and Wansbeck areas. However, the board has included in its capital programme for 1971–72 a scheme for the upgrading of the maternity unit at Preston Hospital at an estimated cost of £80,000.

I now turn to the main subject the hon. Lady has raised. She has taken a keen interest in the development of hospital services in Newcastle, as has my hon. Friend, who has been in correspondence with me. I am grateful to both hon. Members for giving me the opportunity to say something about the way in which we plan the building of a hospital. This is important in view of some slight misconceptions the hon. Lady had about what goes on. I should like to emphasise how much care is taken at all stages to ensure that proper solutions are found to the many complex problems which accompany hospital development. At the same time I hope to allay the hon. Member's apprehensions on certain specific features of the development proposals for the new hospital at Freeman Road.

First, I should like to explain briefly what happens when it is proposed to build a new hospital. After a detailed assessment of needs has been carried out by the hospital authority in whose area the hospital is to be built—in this case the Newcastle Regional Hospital Board—the Board's planning group prepares a working brief for the project team of doctors, nurses, architects, engineers, quantity surveyors, and administrators appointed to see the project through to completion. The brief sets out the operational policies agreed regionally, the outline project policy, the provision made in the Board's capital programme, the content, timing and so on. In assessing the content, the planning group naturally has regard to norms of hospital provision, existing facilities which can be expected to continue to function, and those which will become redundant as the new hospital is developed. When completed, the brief is submitted to the Board, which, if it is acceptable, then passes it to the Ministry.

At this stage the Board's proposals are examined very carefully by the doctors and other professional officers in the Ministry concerned with planning. Their considerable expertise, fortified by their experience of processing similar schemes throughout the country and a knowledge of development in other countries, is brought to bear in advising the Board on both content and cost. The proposed development is thus moulded at the outset into a shape which ensures the correct balance of hospital facilities at a cost which the country can afford.

It then falls to the Board's project team to undertake the detailed planning of the new hospital on the basis of the brief which has been provided to it. For this purpose the Board may use the services of architects employed by it or may engage private architects, but whether the scheme is designed by the Board's own staff or by consultants, the architects are, of course, represented on the project team.

The first job of the project team is to make an evaluation of the several sites which might be suitable for the new hospital, with particular regard to size and shape. This is very important, because site conditions influence the shape of the buildings which can be placed upon the land and these in turn have an important bearing upon the cost of providing the required services and upon recurrent expenditure. The team's object, therefore, is to select a site which will enable the hospital to be provided within the cost limits prescribed and which will keep the "on-costs" to a reasonable level. "On-costs", as hon. Members will know, are the costs which stem from a decision to build on a particular site and cover such items as roads, drains and other services. These can account for very substantial sums, and a careful site appraisal is very necessary to ensure that the layout of the buildings is such that the "on-costs" attracted are themselves contained within the amount which is set aside for them. In the case of hospitals we aim to keep the "on-costs" below 50 per cent. of the aggregate cost of the individual departments. That is to say, the total cost of a new hospital should, given reasonable site conditions, be no more than 1½ times the cost of the provision of the departments and supporting facilities.

Having selected a site which will meet these criteria, the team is required to produce a development control plan. We are now getting to the nub of the right hon. Lady's point. I have had to explain this in greater detail so far because I had hoped to speak to a slightly wider audience than is here this afternoon.

The team is required to produce a development control plan, including draft sketch designs, showing how the various departments which go to make up the new hospital, together with the ancillary services, will be laid out. The reason for this is obvious. The various departments of a hospital are required to function as a unit and it is essential, before the planning is far advanced, to see that departments which are dependent upon one another are created in such a way as to enable them to operate smoothly and with maximum economy in the use of highly-trained staff. These problems are of enormous complexity in the case of hospital development, and when a hospital is to be built in several phases over a period of years, as many of our hospitals are, the need to define the overall picture at the outset is imperative.

In preparing the development control plan the team has access to a wealth of detailed information, including experience drawn from other similar projects, the views of the staff who will ultimately work in the new hospital, and last but by no means least in importance, the ample design guidance which has been issued by my Department in the form of building notes, and other technical documents. This, of course is backed up by a free exchange of views between the professional officers engaged upon the scheme and those in the Ministry concerned with planning. Indeed, the development control plan is a vital link in the building of a new hospital, because once this plan has the approval of the Ministry, the Board is free to go ahead with sketch designs and subsequently to detailed design and tender provided the cost does not vary from the cost limits which have been laid down.

I hope I have convinced the hon. Lady of the extremely careful consideration which is given at all stages to the content, shape, position of departments, staff consequence and future running costs of new hospital development. I have gone into this rather fully in order to put the present status of the plans of the proposed new hospital at Freeman Road into perspective.

The stage which has been reached in the planning of this hospital is the formulation of the development control plan. This was received in the Ministry recently and is now being studied by a team of Ministry experts. The provisional floor plans do indeed show the staff dining room and kitchen on the lower ground floor, and leading off the same corridor, some 60 or more yards away, the internal entrance to the mortuary. Let me explain the thinking which lies behind the siting of a mortuary. It ought to be near the pathology department and have direct vertical or horizontal communication with it. The pathology department in turn must be conveniently placed in relation to operating theatres, wards and out-patients, and the out-patient department should be planned on the ground floor. So it is in this scheme. The Board plan to have the out-patient department at ground floor level, with direct access to X-ray, pharmacy, pathology and physical medicine departments. Since the mortuary should have direct communication with the pathology department, and since it would obviously be highly undesirable to bring mortuary trollies through an area to which patients and visitors have access, it can only, in this instance, go below the pathology department. To site it above the pathology department would be impracticable in this case, because of the requirement for external access and the problem of getting across a lift hall accessible to patients and visitors. It has been proposed, in consequence, to locate the mortuary on the lower ground floor where, owing to site characteristics, it can conveniently be provided beneath the pathology department, with the direct vertical communication to that department which is desirable.

Similar arguments apply in the case of the staff dining room. It should be near the kitchen—it is in fact adjoining the kitchen in the Freeman Road scheme—and the kitchen should be as close as possible to the main circulation to the wards and, at the same time, close to the central stores, which require external access.

The proposals have one disadvantage however. To reach the mortuary from inside the building it would be necessary, under present plans for traffic flow, to bring covered trollies down from the wards on the upper floors of the building and to wheel them from the lift past the staff dining room. I say "from inside the building," because, as hon. Members will understand, there must also be an external access to the mortuary; but it would, of course, be impracticable to take trollies from the wards to the mortuary using an external route. The route at present planned allows for access to the mortuary without contact with patients, visitors and other members of the public, and I should add that, as is customary in all hospitals, every endeavour would be made to avoid moving trollies at inappropriate times.

Having said this, I recognise, however, that there is this objection to the present plan, and I can assure the hon. Lady that alternative solutions are at this moment being examined. The professional officers of the Ministry pay particularly close attention to the development control plan, because this is the latest point at which modifications can be incorporated into the scheme without running the risk of abortive expenditure and work on planning. Together with my officials, I have gone over the draft sketch designs, and we think it may be possible to overcome this difficulty. I understand that the Board is only too ready to look at this again and would welcome suggestions from my Department, which it will receive.

Planning, then, is still in the formative stage. When sketch plans are ready, which is expected to be by about the middle of May, they will be scrutinised by the Board's project committee. If the problem has not been resolved by that time, the Committee will be asked to decide, and the members of the project team will be able to put their views to the Committee to enable it to reach a decision. The Board will still have to aprove the plans, which will probably go to it by about the middle of June.

Finally I should mention the plans for Freeman Road and the possibility of using them for other hospitals in the region. I can set the hon. Lady's mind at rest here, too. I made the point earlier that the site often conditions the shape of the buildings which can be placed on it, having regard to the requirement that the project must be completed within specified limits of cost. The site characteristics at another place in the region might be very different from those at Freeman Road. What the Board has in mind is to try to use in other schemes some of the work done on rooms in departments, because it seems to it that some of these at least are capable of adoption as standard. Such measures reduce the time which needs to be spent on planning this detail, thus freeing the time of skilled and scarce staff for other more important work.

The hon. Lady mentioned the question of a standard hospital. I should like to put her right on one point. I think she is referring to what departmentally we call the "best buy" hospital. The main intention is to standardise as far as possible not only design but components and equipment. This is still very much in the experimental stage. It does not mean that we will have 100 hospitals in the country of exactly the same pattern, but in our view major economies can be achieved in design, equipment and components by this sort of project.